| NPI | 1891738084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: KY 48360) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: OH 35054285-Z) |
| 208100000X Physical Medicine & Rehabilitation (Licence: FL ME115388) | |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2015-12-03 |